1. Service Line Reporting & Management - The demands on IM&T (and Finance) staff.... Steve Bridge Assistant Director of Finance

2. 2 Introduction – The Countess of Chester Hospital NHS FT North West England on border with North Wales Serves population of c250,000 600 beds / £160m turnover 1 st Wave FT Record of good performance Good relationship with Monitor However 20% of our activity not funded at tariff…

3. 3 PLICS / SLR Timeline 1.Decision to Implement PLICSJanuary 2007 2.SLM Pilot SiteApril to May 2007 3.System ShortlistingJune 2007 4.Supplier Decision – BPLAN (Synergy)July 2007 5.Initial System ImplementationSept to Dec 2007 6.1 st cut ReportsJanuary 2008 7.Initial Dashboard ImplementationJan to March 2008 8.Monthly Patient Level SLR ReportsApril 2008 Onwards 9.Dashboard DevelopmentOngoing 10.Business Objects DevelopmentStarting

4. 4 Data Flows & Monthly Processes PAS (Meditech) Data Repository - Patient Activity Synergy Staging Area PLICS (Synergy) Business Objects Reports Intranet Reports (Active Dashboards) Pre PLICS Post PLICS Ledger Costs (Cedar) PBR Income (SLAM)

5. 5 Top-Down Costing Process Overhead Costs Support Service Costs Patient Treatment Service Costs Specialty POD Specialt y POD Specialty POD PathologyPhysioWardsTheatres POD E.g’s Energy, Porters, Capital Charges & Training Levies E.g’s Pathology, Radiology & Divisional Admin E.g. Wards, Theatres, Medical Staff Allocation Tables

6. 6 Top Down Costs – Assumptions & Allocations Cost TypeCost CategoryAllocation MethodInformation Source PTSWardsBed daysPatient Level from PAS PTSTheatresTheatre MinutesPatient Level from Theatre System PTSMedical StaffJob PlansDivisions SSRadiologyWeighted ExamsPatient Level from Rad System SSPathologyWeighted Tests (where weighting available) Pathology systems – mostly at patient level OHCCapital ChargesActual Charges for Equip & Sq Mtrs for Depreciation Estates – paper based OHCEnergySq MtrsEstates – paper based

7. 7 Bottom-Up Costing Process Episode Cost Cost Pool Cost Driver Episode Example Total Episode Cost = £1780.50 Patient Episode ExampleName: John Smith Procedure: W401 Primary Total Prosthetic Replacement of Knee HRG: H04 Primary Knee Replacement Specialty: Trauma & Orthopaedics Point of Delivery: Elective

8. 8 Bottom-Up Costs – Assumptions & Allocations Cost TypeAllocation MethodPatient Level Information Available A&EWeighted AttendancesYes Medical StaffActivity/LOSNo Critical CareWeighted LOSYes PathologyWeighted Tests (where weighting available) Mostly DrugsActivity/LOSNo WardsLOSYes Other - GeneralBased on Activity & LOSNo

9. 9 Costing System – Patient Level Detail Chart illustrating B-U process Patient: John Smith Specialty: Procedure: HRG Point of Delivery Ward Costs

10. 10 The ‘Bubble’ Chart

11. 11 Tools of the Trade 1 - SB Patient Level Information & Costing System - Demonstration & Examples

12. 12 Patient Level Costing

13. 13 Patient Level Costs - 1

14. 14 Patient Level Costs - 2

15. 15 Patient Level Costs - 3

16. 16 PLICS / SLR – Next Steps 1.Continue developing dashboards 2.Drug costs identified at patient level 3.Nurse costs based on patient acuity 4.Use of Business Objects for detailed reporting within Finance 5.Working with Service Lines to continue development of SLR

17. 17 PLICS / SLR - Learning 1.Time to implement depends on starting point 2.Data quality, completeness, architecture 3.Requires dedicated resources in Finance & IM&T 4.IT infrastructure – server speed & capacity 5.Honest relationship with system supplier 6.Don’t underestimate time & resources required 7.Reporting mechanisms are key 8.Iterative process 9.Volume of queries generated – both Finance & IM&T

18. 18 Questions ?